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08080203
CITY OF CUPERTINO � � * >»bry ➢'C'm' :,�5- tf M �# +;'T"i"s' ",'ffivw'e u ` ' CON " T1101 BUILDINGPERMIT C" MN BUILDING ADDRESS: PERMITNO. 21890 DOS PALOS CT H &GH CO 08080203 NER'S NAME: '35iSd M�r`p�y, AkA2 PERMIT LY.UE DATE !sYRNl:I MICHAEL, G AND KATHERINE 5t"" `- __ 08/25/2008 PHONE: SANRARY NO. CONTROL NO. (408) 224-7777 ARCHTTECn GINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 uolp LICENSED CONTRACTOR'S DECLARATION VOA wi 1 hereby alarm that 1 am licorund under Provision Job Description of Chapter 9(commencing p n< with Section 7")ofDivision 3ofthe Business andPmfesdouCode.And mylwcnseIs INSTALL SEWER LINE FROM HOUSE TO PROPERTY LINE -<�Z ho", ai. Lie.N ;E_ _ �-� S RODDIE INC, (H&H CO) RENEWED BL #22876 . F Dam .0 Conuacmr tl aQ W ARCH11711=DECLARATION W7< 1 undersand my plan shall be used u public records N A. O t; Licensed Professional cN5OWNER-BUILDER DECLARATION F 1 hereby aRrm that I em exempt from the Conuactors License Law for the p o following..on.(Seed an 7031.5,Business sed Profc.m.Cale:Any city or county which mnot.a permit m cnunct Alter.improve,demolish,or repair any mctum _I< Prior w is issuance.also requires tM applicant for such permit to file a signed statement Into ho is licensed Pusmanl to Inc Pmviaiow of ore C.--W"-Ucc—Law(ChaPhm9 Sq.Ft. Floor Area Valuation y4$ (commencing with Section 7000)9Division 3ofthe BusinessAnd Professions Cade)or $4000 that he is exempt therefrom and the wsis for the Alleged exemption.Any violation of Section 7031.5 byAny aPPliexnt for a permit subjcus the applicant m a civil Penalty of Number Occupancy ream doe BK hurmtewBI d dolls. 32645019 ane. p y Type D I,As owner of the Property,or my employees with wages as their sole compen ati.r. will do the work.and the sticture is not intended or offend for safe IS".1014,Business and Professions Code:The Contractors License Law does ons apply As an owner of Required Inspections property who holds aimproms dtmeen,and whodoessuch work himselfor through his awncmploy .pro ded NnsuchimpMve Uartnotimmnd oroffemdfault If. however,the building or Improvement is sold within ore yeti of completion.the owner. builder will have the humeri of proving that the,did not build or improse for putpwe of sale.). D 1,as owner of the propert,,am exdwivcly contracting with licensed contractors to construct the project(Sec 7041.Buboes and Professions Cade:)The Conuacmr's U. cave Law docs nm apply w an owner of property who builds or improm thereat sed. who contracts for such projects with a eomu r(s)Iiceued immure,an the Contractors License Law. ❑I am wcmpt undo See BB P C for this maven tic Dam WORKER'S COMPENSATION DECLARATION 1 hereby arm under penny of perjury oro of dm following declarations ❑I hs+e and will milio nua CertificateofCornent m self-inam fawmFNaComperF a...a provided fm by Section 3100 of the Labor Code,for tiro peAormance of the work for which Nis p<nit is issued. I law and will maintain Watrls ComP'• on Insuu¢.u rryuimd by Section 3 of ate Lather Code,for Chep stMentancoofda,wort forwhich this permit u issued. ' My Workers ComPensauw 1�°�exrriu end Policy number ase: Cartier: Sf/d.dy PList.L' Polity Na.:ISYOa�JY`�Q55. CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (Thissection teed not M completed time Permit is for ane hundred della.($100) or less) 1 certify thet in the performarea of the work for which this Permit u issued,I shall nm employ any Pcrmn in any manner on As to become subject to f Workers'Compensation Laws of California Due . Appilca rt NOTICE TO APPLICANT:If.after making this Ccoiftam of Eaemption,you should bacame mbjmt to the Workers C.,namon provisions of the Labor Coda you mwt .J O forthwith comply with such provision m this permit shall be deemed mwokcd. z t 5 CONSTRUCTION LENDING AGENCY I increby affirm that Vert is a covtmcuon lendinga i•+ Ne work for which this agency for the perfurmaco or ani pemhit is issued(See.J09'f,Civ,C.) ALenders Name z lender!Address V Q 1 certify that 1 haw read this application and saw this Ne above info rnadun is it, ^' cones.I agree to comply with All city and county omiunsv and sum laws mlaung An .17 rV^ building consumers..AnW hereby authorise rtpmsemuum of this it,to cacrupon hire r I, •hove-tnanudgm property for lupe.wMfahich may a F 6a I%)agree to ave,indemnify and keep hamtless the City of Cupertino against rA iiebMuc'Judgme the saspcnvmit.'mayin Any way¢true agilns said City V z in conscquerne of the granting of sus permit' `-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 62i Date SOURC�aEsy LATIONS. �S�`' R �`� Re-roofs Siinu ApplicaaX r qw H US MATERIALS DISCLOSURE Type of Roof Wllbye Cuator fMunicipdingacupsntuom.handle hmldwd Sgciy u de0Sce by the Cupertino Munidpal Code.Clapwr 9.13.ad the Health ad Safety .section 255324)7 DTn All roofs shall be inspected prior to any roofing material being installed. No Will thc applicant or future building ac,upam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove crult hcv mow air commrivna u fess by the Bay Amo Air Quality Management all new materials for inspection. Dy u 1h avemadthehavrdnus mase.2553and2ts4.1,Chpwundman G95 of Ina Gilding maHW.MeemlyCada Sts7iau25505.35537and25534.1undcrstsnd thui(thc building sou not cursenOY hew•muni this it u my memorability w noury the occupant of the require In In It mus be met imor m issuancc of a Cuufm,,+k�,,or Occupancy. IgnatUre Of A Date z�� / 1S 2S 8 owner a rothoriad ase Dam g All roof coverings to be Class'n� 'or better � a - CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE . CUPEIF kTINO PERMIT APPLICATION FORM APN # Date: Building Address: � ) D ©s s C - Owner's Name: Phone#: / 13 1:P10y!6 -BC2 s2 Contractor: Phone#: t(� `?979 DC(°< . e_ 6134- p Fax #: 6 Contact: —..... --- Phone #: eeoS 2_2q —9 ? 7 ,7 ^ Fax #: 76 — o S Contractor License #: rfS S 9175 Cupertino Business License #: "`LZ.�7lp Job Description: Residential Commercial ❑ Valuation: en - Project Size: Express F1 Standard Large Major Green Building: Please complete relevant portion of the Green Building Checklist& attach it to the application or if applicable, include in plan set & the sheet index. Green Building Points: Quantity Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP IPGASCOM Commercial Gas Piping System P 1-4 Outlets IBSEISMICOM Seismic Commercial__P 1 IBSEISMICR Seismic Residential P 1PRSEWER Residential building P IRPSS sewer/sanitary sewer CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPERTINO FEE SCHEDULE Quantity Fee ID Fee Description Fee Permit Type Group 1PRREPIPE Residential re-pipe per fixture P 1RPRP IBPWSVCS Water Service P 1CPWS or 1RPWS 1PPRSEWG Private Sewage Disposal System P 1PCESS Cesspool P 1BPWATER Install/alter Water Pipe P 1BPFIXTURE Plumbing Fixture P 1PGASRES Residential Gas Piping System P 1-4 Outlets 1BPGAS Gas Piping System 5+ Outlets P / 1PPERMITFEE Plumbing Permit Fee Issuance P • 1PLMBLNCK Plumbing Plan Check P IPLM 3INSP Other Plumbing/gas Insp. P J1TRAVDOC Travel &Documentation Fee B ` 1BUSLIC Business License B Revised 6-16-08 • CITY OF CUPERTINO 5 ITEMS OF 5 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32645019 . 00 DATE ISSUED. . . . . . . : 08/25/2008 RECEIPT #. . . . . . . . . : BS000005895 REFERENCE ID # . . . : 08080203 SITE ADDRESS . . . . . : 21890 DOS PALOS CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER BYRNE MICHAEL G AND KATHERINE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1130 RECEIVED FROM . . . . : SEAN FRY CONTRACTOR . . . . . . . : ROD HERRICK LIC # 22876 COMPANY . . . . . . . . . . : H & H CO ADDRESS . . . . . . . . . . : 725 PIERCY RD CITY/STATE/ZIP . . . : SAN JOSE, CA 95138 • TELEPHONE . . . . . . . . : (408) 224-7777 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --------- ------- --------- ----- ---------- ---------- ---------- 1BSEISMICR VALUATION 4, 000. 00 0.50 0. 00 0. 50 0. 00 1BUSLIC FLAT RATE 1. 00 110 . 00 0. 00 110. 00 0. 00 1PPERMITFE FLAT RATE 1 . 00 40 .79 0. 00 40 .79 0. 00 1PRSEWER UNITS 1 . 00 20 .40 0. 00 20.40 0. 00 1TRAVDOC FLAT RATE 1 . 00 40 .79 0. 00 40 .79 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 212 . 48 0 . 00 212 .48 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 212 .48 2809 --------------- TOTAL RECEIPT 212 . 48 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- -------- ------------------------ 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 400 SEWER/LATERAL 507 FINAL PLUMBING